Reconstruction of Clival and Craniocervical Junction Defects

Endoscopic endonasal skull base surgery is utilized in the management of pathologies involving the anterior cranial base, petrous apex, clivus, craniocervical junction, and posterior fossa. Reconstruction following ablative surgery in the region of the clivus, craniocervical junction, and posterior fossa poses unique challenges to the skull base surgeon including the three-dimensional contours of the clivus and paraclival internal carotid artery, high cerebrospinal fluid flow of the prepontine cistern, frequent use of radiation therapy, inferior extension of craniocervical junction defects, and the reach and anatomical limits of the commonly used reconstructive flaps. This work aims to review the key considerations specific to the reconstruction of clival and craniocervical junction skull base defects, discuss contemporary evidence for and against particular reconstructive techniques, and review common protocols for perioperative surgical care.